Table of Contents
sensory & motor testing including reflexes, coordination & balance
- to detect the presence of a CNS lesion causing extremity weakness:
- the simplest, most rapid & subtle test is for “drift”:
- the sitting patient is asked to close his eyes & hold his arms out horizontally with palms up for 30secs.
- if weakness is present, the hand & arm on the affected side will slowly drift or pronate.
- lie pt prone with knees bent 90deg. and legs pointing vertically up for 30secs
- a weak leg will tend to drift & drop
- another sensitive test for extremity weakness is hand grasp, & foot plantar and dorsiflexion
- test hand grasp using both hands with examiner's hands crossed in front of him so that one can test pt's ulnar side which is more reliable than radial aspect.
- if abnormal results or peripheral nerve or muscle injury, then more formal testing is needed.
documentation of muscle strength
|score||result of testing|
|4+||Slightly less than full power against strong resistance|
|4||Able to overcome moderate resistance|
|4-||Able to overcome mild resistance|
|3||Able to accomplish full ROM against gravity|
|2||Able to accomplish full ROM with gravity eliminated|
|1||Only trace muscle contraction, may only be palpable|
- as with other aspects of the neuro. exam., if abnormal findings or specific symptoms then more detailed testing is indicated.
- testing for pain sensation is best done by double simultaneous stimulation (as for trigeminal nerve)
- to exclude CNS lesions, if testing on dorsum of hands & feet is normal no further testing for pain is needed
- double simultaneous stimulation with gauze or wisp of cotton wool can be used to test light touch
- NB. light touch is usually spared in unilateral spinal cord lesions
- testing for isolated nerve injuries:
- 2 point discrimination with paper clip ends, normal is 2-8mm on fingertips & up to 75mm on upper arm & thigh
- proprioception is the most sensitive & easiest test for post. column pathway deficits
- move great toe up or down & ask pt which way you moved (upper limb not usually needed to be tested)
- stereognosis is dependent on touch & position sense as well as post. column & sensory cortex function:
- ask pt to identify a familiar object placed in palm (eg. key or paper clip)
- vibration sense is often the 1st sensation lost in peripheral neuropathies such as alcoholism or diabetic:
- place vibrating tuning fork over DIP jt of a finger & the great toe, ask pt to tell you when vibration disappears.
- if sense is absent, move to a more proximal joint
- document as: 0 = absent; 1+ = diminished; 2+ = normal; 3+ = hyperactive; 4+ = hyperactive with clonus;
- symmetric hyporeflexia may be normal or due to sedation, hypercalcaemia
- asymmetric reflexes indicate neurologic or muscular dysfunction.
- to evaluate the L4-5 nerve root (as in disc prolapse) test power of extensor hallucis longus
- +ve Babinski reflex (up-going plantar reflex) indicates an upper motor neuron lesion
reflexes and their spinal cord levels
|Upper Extremity||level||Lower Extremity||level|
|Lower abdomen||T10-12||Anal wink||S3-5|
Coordination and balance:
- cerebellar function:
- place finger on nose test with each hand & eyes closed (or finger to examiner's finger then to pt's nose, eyes open)
- heel-to-shin testing with each leg (ankle to knee and back again)
- rapid alternating movements eg. touch each fingertip with thumb; supinate/pronate hand; tap floor with foot;
- balance is a function of vision, vestibular sense and proprioception, 2 must be intact to maintain balance:
- Romberg test - stand with feet together
- pt with vestibular deficit will report vertigo
- close eyes if proprioceptive deficit, pt will sway ⇒ +ve Romberg's
- tandem gait (heel-toe walking) is sensitive but not specific test of balance.
n_exam_sensorimotor.txt · Last modified: 2010/01/08 02:06 by 127.0.0.1